A team from Vanderbilt University Medical Center has found that pregnant women who have been on opioid painkillers during pregnancy stand a higher chance of having small babies with birth complications or neonatal abstinence syndrome (NAS) -- better known as postnatal withdrawal syndrome.

NAS is often seen in babies born to moms who used opioid drugs such as heroin, codeine, oxycodone (Oxycontin), methadone or buprenorphine during pregnancy. These substances pass through the placenta, making the unborn baby a drug addict even before it has seen its first rays of sunshine.

At birth, these drug-dependent babies show withdrawal symptoms such as vomiting, excessive crying, fever, poor feeding, low weight, sweating and hyperactive reflexes. Nothing a mother wishes for her newborn.

A briefing document from last year for pharmacists and healthcare professionals prepared by the British National Institute for Health and Care Excellence reads, "Opioid analgesics can be used at any stage of pregnancy for the short-term treatment of moderate to severe pain when other analgesics are not effective or not clinically indicated."

However, Dr. Stephen W. Patrick and his team from Vanderbilt University Medical Center shine a new light on the dangers associated with short- and long-term use of opioids.

Opioid painkillers, such as Vicodin, are very similar to heroin or other opioid drugs like codeine, morphine and methadone. According to lead researcher Dr. Patrick, this study is the first to make the link between NAS and legally prescribed drugs. He says that previous research only focused on heroin or illegal narcotic abuse during pregnancy.

Dr. Patrick notes that our doctors need to be more informed about the health dangers of overprescribing drugs during pregnancy. He found that in some cases women who filled a prescription for an opioid pain reliever actually didn't need them for any clear reason.

"In that context, we thought to do one of the first studies of opioid prescribing in pregnancy and its association with infant outcomes," he said in interview with MedPage Today.

The study looked at 112,029 pregnant mothers enrolled in the Medicaid program. Among them, 28 percent were prescribed at least one opioid painkiller during pregnancy by their doctors.

"Not all babies exposed to opioids have drug withdrawal after birth for reasons that aren't entirely clear," Dr. Patrick said. "Our study found that several things increased an infant's risk, including the duration of opioid use, the type of prescription opioid, how many cigarettes a woman smoked and if they used a common antidepressant medicine called selective serotonin reuptake inhibitors."

Dr. Patrick found that infants with NAS and infants whose mothers took opioids while pregnant have a greater chance of being born with a less-than-healthy birth weight compared to babies who were not exposed to opioids. He believes that this is more damaging long-term than the withdrawal symptoms which disappear shortly after giving birth.

"It's riskier to be born low-birth weight than to be born with neonatal abstinence syndrome," Dr. Patrick told Medical Daily while also noting that low birth weight comes with more potential long-term health risks. Though no research into the long-term effects of infant opioid withdrawal has been published, Patrick believes -- based on his knowledge of babies who suffered heroin withdrawal -- "there may be no severe long term consequences" linked to opioid withdrawal, but these children might have "problems with attention."

This new study highlights the need for new policies to reduce the use and overprescription of opioid painkillers during pregnancy.

According to Dr. Patrick and his team, the number of infants in the United States diagnosed with NAS grew nearly threefold from 2000 to 2009, which can be associated with a fourfold increase in opioid pain reliever prescriptions. This accounts for about $720 million in national healthcare expenditures which can dramatically be reduced through better regulations.

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